Does Intra-Articular Platelet Rich Plasma Injection Improve Meniscal Repair Outcomes?

Abstract

Background: Meniscal tear surgeries have many long term sequelae. Intra-articular platelet rich plasma injection is thought to stimulate repair and increase meniscal function. Objectives: To assess the effect of 6-monthly intra-articular injection of platelet rich plasma (PRP) on the pain assessment and functional status of knee joint undergone meniscal repair. Methods: A randomized controlled trial was carried out on thirty patients who had undergone arthroscopic meniscal repair and presented with persistent pain within 4 months after surgery. Half of the patients were randomly intra-articularly injected with 5 mL PRP at 1 month intervals for 6 injections and the other half were not injected and taken as a control group. Clinical examination, visual analogue scale (VAS), knee injury and osteoarthritis outcome score (KOOS) score and Doppler ultrasonography were performed before and after PRP treatment. Results: After 6 months, in the PRP injected group, there was a significant improvement in VAS score (1 (1 -3)) and KOOS score (86.2 ± 4) compared to baseline values (9 (7 -10) and 62 ± 9.8 respectively; P < 0.001) as well as significant decrease in the percentage of degeneration of medial femoral condyle (MFC), lateral femoral condyle (LFC), medial tibial condyle (MTC), lateral tibial condyle (LTC) measured by Doppler Ultrasonography (US), (6.16 ± 3.33 and 9.07 ± 3.66, respectively; P = 0.031). Conclusions:This study showed that intra-articular PRP injection following meniscal repair can be effective in reducing pain, improving knee function, and slowing the rate of cartilage degeneration that accounts for early osteoarthritis.

The role of Platelet-Rich Plasma (PRP) intraarticular injections in restoring articular cartilage of osteoarthritic knees. A systematic review and meta-analysis

“…The search identified 1452 records by title, 14 of which met the inclusion criteria and were included for the analysis [ 10 , 11 , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. Fig.…”

“…Table 1 summarises the characteristics of the 14 included studies [ 10 , 11 , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ]. The methodology of the non-randomised studies was classified according to Mathes and Pieper (2017) [ 30 ].…”

“…The methodology of the non-randomised studies was classified according to Mathes and Pieper (2017) [ 30 ]. Our analysis included seven RCTs (n ​= ​688) [ [10] , [11] , [19] , [22] , [26] , [31] , [32] ]; two prospective (n ​= ​119) [ [24] , [25] ]; one retrospective cohort (n ​= ​68) [ 21 ]; and 4 case-series (n ​= ​244) [ 20 , 23 , 27 , 28 ]. The total number of participants included was 1119 (1,169TKAs).…”

“… Lead author (Year) Study design (Level of evidence, Country) No. of patients (knees) Diagnosis Stage of OA Age (years) Gender (M:F) BMI (kg/m 2 ) Treatment received (knees) Bansal (2021) [ 19 ] RCT (I, USA) 132 (132) Knee OA K-L grades I-III PRP : 64.4 (52–74) Control : 65.8 (54–73) PRP : 39:25 Control : 42:26 NR PRP: 64 Control (HA): 68 Bennell (2021) [ 11 ] RCT (I, Australia) 288 (288) Knee OA K-L grades II, III PRP : 62.2 ​± ​6.3 Control : 30.1 ​± ​4 NSD PRP : 59:85 Control : 60:84 NSD PRP : 29 ​± ​3.7 Control : 29.6 ​± ​4.5 NSD PRP: 144 Control (placebo): 144 Raeissadat (2020) [ 10 ] RCT (I, Iran) 42 (42) Knee OA K-L grades I-III 57.57 ​± ​5.9 All females 28.49 ​± ​3.24 PRP: 21 Control (exercise): 21 Elik (2020) [ 32 ] RCT (I, Turkey) 57 (57) Knee OA K-L grades I-III 60.77 ​± ​7.36 (50–75) 4:53 PRP: 1:29 Control: 3:24 PRP: 30.37 ​± ​4.47 Control: 30.70 ​± ​3.97 PRP: 30 Control: 27 Buendía-López (2019) [ 31 ] RCT (I, Spain) 99 (99) Knee OA K-L grades I-II 56.82 (50–63) PRP: 16:17 HA: 15:17 NSAID: 17:16 25.1 (23.8–26.1) PRP: 33 Control groups : HA: 32 NSAID: 33 Elnemr (2019) [ 22 ] RCT (I, Egypt) 30 (30) …”

“… Areas of measurement No. of studies (knees) Estimated difference in means (95%CI) Heterogeneity τ 2 I 2 Q value P value MFC 5 (313) [ 20 , 22 , 23 , 27 , 28 ] 0.068 (−0.05 - 0.185), p ​= ​0.259 0.01 86.284 29.163 <0.001 LFC 4 (210) [ 22 , 23 , 27 , 28 ] 0.064 (−0.02 - 0.148), p ​= ​0.136 0.002 24.568 3.977 0.264 MTP 2 (87) [ 22 , 23 ] −0.105 (−0.290 - 0.079), p ​= ​0.263 <0.001 <0.001 0.804 0.370 LTP 2 (87) [ 22 , 23 ] −0.019 (−0.214 – 0.176), p ​= ​0.848 <0.001 <0.001 0.648 0.421 Overall (MFC, LFC, MTP, LTP) 3 (145) [ 22 , 24 , 26 ] −0.075 (−0.300 – 0.150), p ​= ​0.513 0.017 44.705 3.617 0.164 PRP: Platelet-Rich Plasma, CI: Confidence Interval, MFC: medial femoral condyle, LFC: lateral femoral condyle. MTP: medial tibial plateau, LTP: lateral tibial plateau, p<0.05: significant.…”